Karuthan Chinna

An exploratory study on risk factors for chronic non-communicable diseases among adolescents in Malaysia: overview of the Malaysian Health and Adolescents Longitudinal Research Team study (The MyHeART study)

BackgroundThe National Health & Morbidity Survey (NHMS) IV (2011) observed that the prevalence of obese children aged less than 18 years in Malaysia is 6.1% compared to 5.4% overweight and obese in NHMS III (2006). As such, this observation is of public health importance as obesity is a forewarning risk factor for chronic diseases such as type-2 diabetes, cardiovascular diseases (CVD) and certain types of cancers. This MyHeART (Malaysian Health and Adolescents longitudinal Research Team) study aims to examine risk factors of non-communicable diseases (NCD) among adolescents.Methods/designThe MyHeART study is longitudinal cohort study of 1361 schoolchildren (13-years old) attending 15 public secondary schools from the central (Kuala Lumpur and Selangor) and northern (Perak) regions of Peninsular Malaysia. The study used a stratified sampling design to select the study participants. Data collected at baseline included socio-economic, lifestyle (e.g. smoking, physical activity assessment, fitness assessment, seven-day diet history), and environmental information, anthropometric measurements, blood pressure, handgrip strength and bone mineral density. Blood samples for fasting blood glucose and lipid profiles, full blood count, renal profile, as well as bone profile and serum vitamin D were taken. This study cohort will be followed up again when participants turn 15, 17 and lastly, after a period of ten years (around the age of 27).ResultsNine percent of the adolescents from this study were obese. More male participants smoked compared to female participants (15.4% vs. 4.7%). Adolescent males had higher fasting blood glucose but the female participants had lower high density lipoprotein (HDL-cholesterol) and higher low density lipoprotein (LDL-cholesterol). In addition, adolescents from the rural area had higher fasting blood glucose, diastolic blood pressure, total cholesterol and LDL-cholesterol.DiscussionOur results demonstrated that adolescents from the rural area are at higher risk of NCDs compared to their urban counterpart. Tailor made public health interventions are highly recommended for adolescents as this may minimise the dreadful NCD burden in adulthood and health disparity between the rural and urban in the near future.

Effect of a reminder system using an automated short message service on medication adherence following acute coronary syndrome.

Background: Medication non-adherence leads to a vast range of negative outcomes in patients with coronary artery disease. An automated web-based system managing short message service (SMS) reminders is a telemedicine approach to optimise adherence among patients who frequently forget to take their medications or miss the timing. Aim: This paper sought to investigate the effect of automated SMS-based reminders on medication adherence in patients after hospital discharge following acute coronary syndrome (ACS). Methods: An interventional study was conducted at a tertiary teaching hospital in Malaysia. A total of 62 patients with ACS were equally randomised to receive either automated SMS reminders before every intake of cardiac medications or only usual care within eight weeks after discharge. The primary outcome was adherence to cardiac medications. Secondary outcomes were the heart functional status, and ACS-related hospital readmission and death rates. Results: There was a higher medication adherence level in the intervention group rather than the usual care group, (χ2 (2)=18.614, p<0.001). The risk of being low adherent among the control group was 4.09 times greater than the intervention group (relative risk =4.09, 95% confidence interval (CI) 1.82–9.18). A meaningful difference was found in heart functional status between the two study groups with better results among patients who received SMS reminders, (χ2 (1) = 16.957, p<0.001). Conclusion: An automated SMS-based reminder system can potentially enhance medication adherence in ACS patients during the early post-discharge period.

Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: a six months randomized trial

BackgroundGestational Diabetes Mellitus (GDM) increases risks for type 2 diabetes and weight management is recommended to reduce the risk. Conventional dietary recommendations (energy-restricted, low fat) have limited success in women with previous GDM. The effect of lowering Glycaemic Index (GI) in managing glycaemic variables and body weight in women post-GDM is unknown.ObjectiveTo evaluate the effects of conventional dietary recommendations administered with and without additional low-GI education, in the management of glucose tolerance and body weight in Asian women with previous GDM.MethodSeventy seven Asian, non-diabetic women with previous GDM, between 20- 40y were randomised into Conventional healthy dietary recommendation (CHDR) and low GI (LGI) groups. CHDR received conventional dietary recommendations only (energy restricted, low in fat and refined sugars, high-fibre). LGI group received advice on lowering GI in addition. Fasting and 2-h post-load blood glucose after 75 g oral glucose tolerance test (2HPP) were measured at baseline and 6 months after intervention. Anthropometry and dietary intake were assessed at baseline, three and six months after intervention. The study is registered at the Malaysian National Medical Research Register (NMRR) with Research ID: 5183.ResultsAfter 6 months, significant reductions in body weight, BMI and waist-to-hip ratio were observed only in LGI group (P<0.05). Mean BMI changes were significantly different between groups (LGI vs. CHDR: -0.6 vs. 0 kg/m2, P= 0.03). More subjects achieved weight loss ≥5% in LGI compared to CHDR group (33% vs. 8%, P=0.01). Changes in 2HPP were significantly different between groups (LGI vs. CHDR: median (IQR): -0.2(2.8) vs. +0.8 (2.0) mmol/L, P=0.025). Subjects with baseline fasting insulin≥2 μIU/ml had greater 2HPP reductions in LGI group compared to those in the CHDR group (−1.9±0.42 vs. +1.31±1.4 mmol/L, P<0.001). After 6 months, LGI group diets showed significantly lower GI (57±5 vs. 64±6, P<0.001), GL (122±33 vs. 142±35, P=0.04) and higher fibre content (17±4 vs.13±4 g, P<0.001). Caloric intakes were comparable between groups.ConclusionIn women post-GDM, lowering GI of healthy diets resulted in significant improvements in glucose tolerance and body weight reduction as compared to conventional low-fat diets with similar energy prescription.

Diffusion tensor imaging parameters in mild traumatic brain injury and its correlation with early neuropsychological impairment: A longitudinal study

Abstract We explored the prognostic value of diffusion tensor imaging (DTI) parameters of selected white matter (WM) tracts in predicting neuropsychological outcome, both at baseline and 6 months later, among well-characterized patients diagnosed with mild traumatic brain injury (mTBI). Sixty-one patients with mTBI (mean age=27.08; standard deviation [SD], 8.55) underwent scanning at an average of 10 h (SD, 4.26) post-trauma along with assessment of their neuropsychological performance at an average of 4.35 h (SD, 7.08) upon full Glasgow Coma Scale recovery. Results were then compared to 19 healthy control participants (mean age=29.05; SD, 5.84), both in the acute stage and 6 months post-trauma. DTI and neuropsychological measures between acute and chronic phases were compared, and significant differences emerged. Specifically, chronic-phase fractional anisotropy and radial diffusivity values showed significant group differences in the corona radiata, anterior limb of internal capsule, cingulum, superior longitudinal fasciculus, optic radiation, and genu of corpus callosum. Findings also demonstrated associations between DTI indices and neuropsychological outcome across two time points. Our results provide new evidence for the use of DTI as an imaging biomarker and indicator of WM damage occurring in the context of mTBI, and they underscore the dynamic nature of brain injury and possible biological basis of chronic neurocognitive alterations.

Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: a retrospective cohort study

Objective This study aims to examine the validity of the Framingham general cardiovascular disease (CVD) risk chart in a primary care setting. Design This is a 10-year retrospective cohort study. Setting A primary care clinic in a teaching hospital in Malaysia. Participants 967 patients’ records were randomly selected from patients who were attending follow-up in the clinic. Main outcome measures Baseline demographic data, history of diabetes and smoking, blood pressure (BP), and serum lipids were captured from patient records in 1998. Each patients Framingham CVD score was computed from these parameters. All atherosclerotic CVD events occurring between 1998 and 2007 were counted. Results In 1998, mean age was 57 years with 33.8% men, 6.1% smokers, 43.3% diabetics and 59.7% hypertensive. Median BP was 140/80 mm Hg and total cholesterol 6.0 mmol/L (1.3). The predicted median Framingham general CVD risk score for the study population was 21.5% (IQR 1.2–30.0) while the actual CVD events that occurred in the 10 years was 13.1% (127/967). The median CVD points for men was 30.0, giving them a CVD risk of more than 30%; for women it is 18.5, a CVD risk of 21.5%. Our study found that the Framingham general CVD risk score to have moderate discrimination with an area under the receiver operating characteristic curve (AUC) of 0.63. It also discriminates well for Malay (AUC 0.65, p=0.01), Chinese (AUC 0.60, p=0.03), and Indians (AUC 0.65, p=0.001). There was good calibration with Hosmer-Lemeshow test χ2=3.25, p=0.78. Conclusions Taking into account that this cohort of patients were already on treatment, the Framingham General CVD Risk Prediction Score predicts fairly accurately for men and overestimates somewhat for women. In the absence of local risk prediction charts, the Framingham general CVD risk prediction chart is a reasonable alternative for use in a multiethnic group in a primary care setting.

Gene expression profiling of the peripheral blood mononuclear cells of offspring of one type 2 diabetic parent

Several lines of evidence from studies of both twins and offspring of people with type 2 diabetes have shown the importance of genetics in its pathogenesis. Impaired glucose tolerance (IGT) may reflect these genetic changes during the prediabetic stage. Thus, we performed a comprehensive analysis of the gene expression profiles of the peripheral blood mononuclear cells among offspring of one type 2 diabetic parent with normal glucose tolerance and impaired glucose tolerance in comparison to newly diagnosed diabetics and normal controls. Data were analysed from offspring of one type 2 diabetic parent. Gene expression profiles of 84 genes related to insulin-responsive genes were analysed using human insulin signalling pathway array. Of the 84 genes, 42 diabetic genes had at least a twofold change in expression for at least one comparison between the diabetic subjects, offspring with NGT and offspring with IGT as compared with controls. The most significant findings were that FOXP3 and SNAP25 were highly expressed in the offspring with IGT as compared with the controls, with a sixfold change in expression. The differential expression of the 42 genes among the offspring with IGT mainly demonstrates a defect in insulin secretion which suggests β cell dysfunction. The preponderance of experimental evidence favours the presence of impaired rather than excessive insulin secretion in the offspring before the development of IGT and thus supports the concept that the initial lesion in type 2 diabetes may involve impaired insulin secretion rather than insulin resistance. The results from our study suggest that β cell dysfunction starts early in the pathologic process and does not necessarily follow the stage of insulin resistance.

Glutamine treatment attenuates hyperglycemia-induced mitochondrial stress and apoptosis in umbilical vein endothelial cells

OBJECTIVE: The aim of this study was to determine the in vitro effect of glutamine and insulin on apoptosis, mitochondrial membrane potential, cell permeability, and inflammatory cytokines in hyperglycemic umbilical vein endothelial cells. MATERIALS AND METHODS: Human umbilical vein endothelial cells were grown and subjected to glutamine and insulin to examine the effects of these agents on the hyperglycemic state. Mitochondrial function and the production of inflammatory cytokines were assessed using fluorescence analysis and multiple cytotoxicity assays. Apoptosis was analyzed by the terminal deoxynucleotidyl transferase dUTP nick end-labeling assay. RESULTS: Glutamine maintains the integrity of the mitochondria by reducing the cell permeability and cytochrome c levels and increasing the mitochondrial membrane potential. The cytochrome c level was significantly (p<0.005) reduced when the cells were treated with glutamine. An apoptosis assay revealed significantly reduced apoptosis (p<0.005) in the glutamine-treated cells. Moreover, glutamine alone or in combination with insulin modulated inflammatory cytokine levels. Interleukin-10, interleukin-6, and vascular endothelial growth factor were up-regulated while tumor necrosis factor-α was down-regulated after treatment with glutamine. CONCLUSIONS: Glutamine, either alone or in combination with insulin, can positively modulate the mitochondrial stress and cell permeability in umbilical vein endothelial cells. Glutamine regulates the expression of inflammatory cytokines and maintains the balance of the mitochondria in a cytoprotective manner.

Effectiveness of a patient self-management programme for breast cancer as a chronic illness: a non-randomised controlled clinical trial

PurposePatient self-management enables living with a chronic disease effectively. This study examines the effectiveness of a 4-week self-management programme to enable self-management of the numerous after-effects and with breast cancer as a chronic disease.MethodsUpon ethical approval, 147 multiethnic survivors (stages I–III breast cancer) received either a 4-week self-management intervention (n = 68) or usual care (n = 78) on a controlled clinical trial in a medical centre. The facilitator-led group intervention provides self-management support and skills for managing the medical, emotional and role tasks. Survivors completed the pre- and post-intervention measures on quality of life, distress and participation inventory.ResultsMultiple analyses of covariance (adjusted for baseline measures) showed significant differences between groups [F(6, 129) = 2.26, p = 0.04 at post-test and F(6, 129) = 4.090, p < 0.001 at follow-up]. Post hoc analysis indicated significantly better outcome on all measures. At follow-up, the experimental group had a mean quality of life (QOL) score of 3.39 [CI = 1.37–5.42; p = 0.001] greater than the control.ConclusionsThere is preliminary evidence that the 4-week self-management intervention enhance the QOL of women with breast cancer, by enabling them to better self-manage the numerous medical, emotional and role tasks. Further randomised trials are warranted.Implication for Cancer SurvivorsSurvivors receiving self-management programme report improved HRQL compared with those on usual care. Although time can attenuate the participation limitation and distress of survivors, self-management programmes could help to increase patients’ self-efficacy for better self-management.

Suicide prevention program for at-risk groups: pointers from an epidemiological study.

OBJECTIVES The aim of this paper is to identify at-risk groups for a focused suicide prevention program for Malaysia. METHODS Data from 20,552 persons aged 16 years and above (males 45.9%), was obtained using stratified, random sampling in a national survey of psychiatric morbidity using locally validated General Health Questionnaire (GHQ-28) which included questions on suicidal ideation. RESULTS The overall prevalence of suicidal ideation (SI) was 6.3%, CI 6.1-6.8 (n=1288). Logistic regression analysis was performed with age, ethnicity, gender, urban/rural residence, age group, marital status, household income, type of household, presence of chronic pain, social dysfunction, somatic, anxiety or depressive symptoms, obesity, and chronic medical illnesses as independent variables. Only Insomnia, Religion, Marital Status, Depression, Social Dysfunction and Anxiety were seen to be significant predictors. Prevalence of SI was significantly higher among Indians (11.0%, CI 9.5-12.5), especially those of the Hindu faith (12.2%, CI 10.5-14.0), Chinese (9.7%, CI 8.8-10.7) and those having depressive symptoms. CONCLUSION In a developing country with competing priorities, prudent allocation of resources requires focusing suicide prevention efforts on treating depression in vulnerable groups.

Effect of nonsurgical periodontal therapy verses oral hygiene instructions on Type 2 diabetes subjects with chronic periodontitis: a randomised clinical trial

Background40 subjects with type 2 diabetes and moderate to severe CP were randomly distributed to groups receiving either NSPT or OHI. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, 2- and 3-months intervals.Methods40 subjects with type 2 diabetes and moderate to severe CP were randomly distributed to groups receiving either NSPT or OHI. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, 2- and 3-months intervals.Results15 subjects from NSPT group and 17 from OHI group completed the study. The difference in plaque index (PI) between NSPT and OHI groups were significant at 2 months recall (p = 0.013). There was no significant difference between NSPT and OHI group for all other clinical periodontal parameters, HbA1c and CRP levels. At 3 months post-therapy, periodontal parameters improved significantly in both groups with sites with probing pocket depth (PPD) < 4 mm reported as 98 ± 1.8% in NSPT group and 92 ± 14.9% in OHI group. Mean PPD and mean probing attachment loss (PAL) within the NSPT group reduced significantly from baseline (2.56 ± 0.57 mm, 3.35 ± 0.83 mm) to final visit (1.94 ± 0.26 mm, 2.92 ± 0.72 mm) (p = 0.003, p < 0.001). For OHI group, improvements in mean PPD and mean PAL were also seen from baseline (2.29 ± 0.69 mm, 2.79 ± 0.96 mm) to final visit (2.09 ± 0.72 mm, 2.62 ± 0.97 mm) (p < 0.001 for both). Similarly, HbA1c levels decreased in both groups with NSPT group recording statistically significant reduction (p = 0.038). Participants who demonstrated ≥ 50% reduction in PPD showed significant reductions of HbA1c and hs-CRP levels (p = 0.004 and p = 0.012).ConclusionNSPT significantly reduced PI at 2 months post-therapy as compared to OHI. Both NSPT and OHI demonstrated improvements in other clinical parameters as well as HbA1c and CRP levels.Trial registrationClinicalTrials.gov: NCT01951547.